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Another blip on our path back to EBF :(

My LO, now 7.5 weeks, has not gained any weight in the last 3 weeks according to the scales at my doctor's surgery. My own scales (same brand, different model) indicate a 2oz gain - not much better.

He'd lost 10% of his birthweight by day 5 and took 3 weeks to regain it. We have been supplementing with formula to varying degrees since day 6

A TT was diagnosed and divided at 2.5 weeks; I believe I messed up my supply around that time by not BFing (extreme nipple pain) and because expressing has never yielded much so i gave up. After healing...lots of nursing and we managed 3 days of EBF! But my scales showed a loss that week so I went back to supplements (in hindsight I realised I had dropped them too quickly). For the last 2 weeks I've used an SNS and now a Lact-Aid to supplement.

I suspect a milk transfer issue and spoke to a nurse about this at yesterday's weigh-in. She checked his latch and said if looked fine (she's not an LC though) and suggested Domperidone which I started yesterday. I'd already tried More Milk Plus but hadn't seen much effect in 10 days. He's been on 200-300ml (6-10oz) of formula a day for the last week.

Today we had a MARATHON nursing day. He woke me at 4.30 am and fed for 15 mins on each side. Then he woke at 7.30 and except for a few 10-minute breaks and a couple of longer ones (30/45 mins) he has been at the breast from then until 11.30pm! Some of the time had has been comfort sucking; he has also dozed off a lot but will wake up rooting and crying and did this throughout the breaks. I didn't give any supplement until about 6pm today as that's when his usual fussy period begins. He's had about 250ml (8oz) today, 120ml (4oz) of it at 1am as after his only proper nap today at midnight, he was screaming.

I've seen a difference with the Domperidone and want to keep taking it but I still think there must be an intake issue because surely this is not normal behaviour even for cluster feeding? He must have been trickle feeding all day if he was still hungry after so many hours? The IBCLC I saw is on sick leave at the mo so I can't see her just yet.

I should also add that in the last 2-3 weeks he has started sleeping for longer stretches at night (from 1am until about 6.30) so I think this, and a transfer issue are at the root of the weight gain problems. But I would welcome any advice or shared experiences!

Re: Another blip on our path back to EBF :(

Just a few thoughts came to mind while I read your situation.

1) have you considered pumping at least once during his long sleeping stretches? Even if you don't yield much milk, you may benefit from the additional stimulation between feeds. What kind of pump have you used? Hospital-grade pumps can help build supply, others either maintain supply or less. Also, hand expression after both pumping & nursing sessions can further empty the breast to stimulate an increase in supply. Try this link http://newborns.stanford.edu/Breastf...xpression.html for great video to show you how to effectively hand express.

2) the long nursing day sounds like your baby initiated a nursing vacation which can actually help increase your supply. Watch to see how your supply is after having had such an intense day. Can you tell how we'll your LO is transferring milk? You may want to work with an IBCLC to evaluate the milk transfer. Are there other IBCLCs in your area who can help while the one is out sick? Maybe a local hospital has one on staff?

3) keep working with your health care providers to keep a close eye on the weight situation like you are doing.

4) you are working so hard & deserve to know what a wonderful mother you are. Your baby is benefitting from all your hard work. We all support you & your efforts here.

Re: Another blip on our path back to EBF :(

I pumped after BF and giving the formula last night, and will try again today but it's already shaping up to be a repeat of yesterday

My pump is a hospital grade rental from Ameda.

I'm going to try encouraging more sleep today so have got the baby carrier out...I reckon he only had about 5-6 hours in total yesterday. He just seems really cranky. And he's crying differently - sometimes quite a low sob, at others he's screaming. He stops quickly when picked up but then resumes... it sounds a lot like he's tired. So we'll try sleep, BF on demand and see how we go. I can hear a lot of intestinal gurgling and he sometimes arches his back and cries at the breast so I'm not ruling a tummy problem. He has had these symptoms for a while but they intensified yesterday and haven't been that disruptive till now.

I have no idea how well he's transferring milk. He had one big BM yesterday and produced lots of very wet diapers so that should indicate confident he took enough in. But then he was at the breast most of the day!

My IBCLC is based at a local hospital where she is also the supervising midwife - there are a few closer to me but because my address is over the county border (by half a mile) they are reluctant to come out to me. Unbelievable. I'd be paying their travel costs anyway but the attitude put me off seeing them.

Re: Another blip on our path back to EBF :(

I wonder if your IBCLC would be willing to Skype with you? Sounds like you are really determined to do this. Be proud of yourself for persisting. Every ounce of breastmilk is a wonderful gift to your baby, try not to be discouraged by needing to supplement.

Here's some videos from Jack Newman's site:

It will show you what to watch for, as far as milk transfer goes. You will see your baby's chin drop when a mouthful of milk is swallowed.

It won't take too long for the domperidone to kick in and you will probably find it much more effective than the herbs.

Have you gotten ahold of the book Making More Milk? There's lots of good info in there.

One suggestion in there is to feed the baby the formula supplement *before* breastfeeding. The general idea is to feed slightly less formula than you normally would at the end of the feeding. There are alot of benefits to this including perking the baby up so he can breastfeed more effectively.

Reducing supplements will need to be done gradually.

I will check back. You can do this!

Canadian mom and breastmilk fan.
We have 2 beautiful children: Luana who's 9 y/o, had breastmilk for 2 years and is smart as a whip. Lucas who came out kickin', is 4 y/o and continues to enjoy his milkies.

Re: Another blip on our path back to EBF :(

Update: I weighed him yesterday and he showed no gain since Friday. I wanted to get a referral to a paediatrician (I'm in the UK so you need your doctor to initiate this for you unless you go for private healthcare) so I saw the doc yesterday. He wasn't that helpful in terms of listening to me or suggesting solutions but then I wasn't expecting much other than the referral

I'm waiting to hear from the paediatrician and today we're seeing a cranial osteopath. The IBCLC had suggested bodywork to assist with our latch. Although it's better now I still see tension in him - he was an emergency c-section due to his head being flexed back so perhaps he's got some left over issues.

We do have Making More Milk - I've been following the supplementation advice in there but am desperate to wean him off the formula. Today he's been settled enough for me to start pumping so I'm going to aim for doing one side while nursing on the other today, as many times as I can. I can't put him down long enough to double pump - he only really sleeps properly by day when in the car or sling so not ideal pumping situations

Oh - and when the referral comes in the paediatrician is at the same hospital as my IBCLC (she's a midwife there) so I'm going to insist she's involved in any plans. My doctor's advice on the lack of weight gain: "it's a matter of time, so keep doing what you're doing". This was said without asking how I'm feeding him! Also I had to ask what he meant by "a matter of time"...he thinks the weight gain has just stalled. Mmm...not very reassuring!

Re: Another blip on our path back to EBF :(

That's a really good idea to pump on one side while he nurses on the other. I had forgotten about that. Supposedly you get more milk because your let-down works better. I double pumped with DD and remember how hard it was to look after a baby and double-pump!! I think what I used to do was feed her first while pumping on 1 side at a time, then put her in a swing (to fall asleep) then double-pump and use breast compressions to get the last bit of milk out, then go to bed myself!

Sounds like you've got good help and the best information.

Wondering how the domperidone's working and what does you're own? I know Dr Newman has a range of doses he prescribes.

Are you using breast compressions?

One more thing I remembered for increasing supply is switch nursing. You nurse on one side until even with breast compressions, you're not observing much swallowing. Then you switch to the other side, then back again.
So for instance, you could feed on both sides twice in each feeding: left, right, left, right, doing breast compressions at the end of each side. Sometimes it can make moms a little crazy doing this, so if you find it interferring with your enjoyment of breastfeeding, maybe best not to do it. However, it is kind of amazing how just when you think one side is "done", if you offer your baby that side a 2nd time, there is a surprising amount of milk left.

Don't feel bad about having to use formula, your baby's still getting a ton of breastmilk. #1 rule is to feed the baby and make sure he's gaining right, then you can gradually decrease the formula as your own supply builds.

My guess is if you keep up with the feeding, pumping, domperidone, and all the other stuff you're doing, you will be able to meet your goals.

Let us know how it goes.

Last edited by @llli*monika.h; October 3rd, 2012 at 01:09 AM.

Canadian mom and breastmilk fan.
We have 2 beautiful children: Luana who's 9 y/o, had breastmilk for 2 years and is smart as a whip. Lucas who came out kickin', is 4 y/o and continues to enjoy his milkies.

Re: Another blip on our path back to EBF :(

An overall positive update

LO has now gained 10oz after being stuck around the 8lb mark for nearly 4 weeks. I'm still supplementing with formula (200-300ml/7-10oz per day) via a Lact-Aid to get his weight up and once he hits 9lbs next week I'm going to start decreasing the formula. I now believe the supply problem we had due to the early rocky patch is only part of the problem as I've discovered he has a lip tie which is affecting milk transfer. I'm seeing my IBCLC next week to discuss this and STILL awaiting the referral to the paediatrician.

I've been off the Domperidone for a couple of days now due to developing an infection on one side. Possibly thrush (there's itching around the breast and a white area - not a blister - on the nipple and pain within the breast and inside the nipple. Otherwise the nipple is not "thrushy"), possibly a bacterial infection and after a very tearful day yesterday I'm now on meds for both. I'm also using a GSE solution on the nipple. What a difference a day makes - I fed 2x on that side today and its miles better. Huge relief as I was getting nothing from the pump!

Re: Another blip on our path back to EBF :(

Yeah for weight gain! Good news!! Sounds like you've had a rocky start but are on your way.

Canadian mom and breastmilk fan.
We have 2 beautiful children: Luana who's 9 y/o, had breastmilk for 2 years and is smart as a whip. Lucas who came out kickin', is 4 y/o and continues to enjoy his milkies.